The CDC is planning to scale back its main disease surveillance system, BioSense, and will now only focus on tracking diseases that occur in the largest cities in the United States. While this might be due to budget cuts, this strikes me as a foolhardy decision. To focus only on the larger cities is to miss the sources of possible outbreaks. While in decades past this might have still provided enough time to stem the outbreak, nowadays, when travel is routine and widespread, epidemics can spread to the entire United States extremely rapidly (here are some flu simulations, for example). By limiting detection to only large cities, this might remove the element of early-warning and possibly make it too late for proper counter-measures (by the time the outbreak is detected, it has already gone national or international). If the CDC has done simulations and studies that show that the lead-time gained is negligible, that would be good to know and would assuage my concerns, but I have not heard anything about that. If you are aware of anything like this, please let me know.